Full Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* MM slash DD slash YYYY Age*Please Note: You must be at least eight years old to be baptized at James River Church.Have you accepted Jesus as your Savior?* Yes Not Yet Date of Salvation* MM slash DD slash YYYY Check if you do not know your exact date of salvation Approximately when were you saved?*At which campus would you like to be baptized?*Select OneSouth Campus - Ozark, MOWest Campus - Springfield, MONorth Campus - Springfield, MOJoplin Campus - Joplin, MOWhat date would you like to be baptized?* MM slash DD slash YYYY NOTE: Baptisms at the North Campus are held following the 10:45 service each Sunday.After which Sunday service time do you prefer?* Sunday 9:00 AM Sunday 10:45 AM After which Sunday service time do you prefer?* Sunday 10:45 AM EmailThis field is for validation purposes and should be left unchanged.
